Updated at 11pm

GROUPS REPRESENTING CHILDREN and people in care have expressed serious concern after a report into a special care unit for children found they were forced to urinate on the floor as they were not given access to the toilet.

The Ballydowd Special Care Unit in Lucan was inspected by health watchdog Hiqa in July of this year. At the time of inspection ten children – aged between 11 and 17 – were being cared for.

Under ‘special care’ children are detained under a High Court order, on the basis that they pose a serious risk to themselves or others.

The child’s liberty is restricted in order to secure their safety and welfare needs.

There are three such units in Ireland.

Single separation

The term ‘single separation’ is used to describe the isolation of a seriously disruptive young person for “as short a period as possible” according to Hiqa.

“The separation of a young person from their peer group is an extreme measure as it may involve the locking of a child in a pre-designated part of the unit such as into one room,” according to the health watchdog’s definition.

Here’s what inspectors found:

“Children told inspectors that being placed in single separation was often very difficult for them. Some children described feelings of being ‘lonely’ and ‘sad’.

“Some children told inspectors it would be better if it could not be used with children because of how it made them feel. Two children sometimes asked to be put into the secure room as they felt safe there.”

It was criticised today by EPIC, a group representing people in care. Director Jennifer Gargan said it should only be used as a last resort.

This report highlights poor practices in relation to the application of single separation. It is an inhumane and degrading practice that is in clear breach of the UN Convention on the Rights of the Child where some young people had no access to basic toilet facilities or a mattress to sleep on despite some young people being in isolation rooms for days.

Tanya Ward of the Children's Rights Alliance: "Children should not be subjected to inhuman or degrading circumstances at any time." Mark Stedman / Photocall Ireland Mark Stedman / Photocall Ireland / Photocall Ireland

Some of the experiences described by children and reflected in records examined by inspectors could be deemed “humiliating or degrading treatment in contradiction with Article 37(c) of the UN Convention of the Rights of the Child,” the report said.

However:

“Inspectors were informed that these interventions were deemed necessary as part of the child’s risk assessments to ensure their safety.”

Urination

As part of their visit, inspectors reviewed records which showed two children had urinated on the floor of the safe room “as they were not permitted access to a toilet on the basis of risk”.

“However, the actual risk was not clearly defined.

“In interviews with inspectors, one child described not being allowed access to a toilet as ‘disgusting’. Another young person did not have access to a shower until day 4 of a 5 day period of continuous single separation.”

“Instead the young person was provided with baby wipes.

“On exploration of this practice, inspectors found that a secure door was placed into the toilet alcove to prevent access as it was a ‘blind spot’ and therefore a child could not be seen by staff members during observations from the corridor.

Inspectors concluded:

“For some children the risk was that they could engage in self-harm. The flaws in the design of a room should not justify these practices and children should have appropriate access to a toilet and shower facility during single separation.”

No mattresses or blankets

Hiqa found that some children were locked in secure rooms for unnecessarily long periods, with no access to fresh air or exercise.

Some children were forced to remain overnight in the secure rooms without mattresses and blankets.

Hiqa: Read the report here Hiqa: Read the report here

Staff assaulted

The Hiqa inspection was triggered after they received a report of concern about the centre.

In the months before the health watchdog’s visit, two staff members had been seriously assaulted, the buildings had been considerably and repeatedly damaged, and a number of children were said to be “of serious concern” to staff due to their self-harming.

“There was evidence that the staff team and management recognised the vulnerability of this group of teenagers despite repeated episodes of significantly challenging behaviour”, the inspectors said.

Response

In its response to the report, Child and Family Agency Tusla said that “on occasion when faced with intense and sustained pressure from challenging and violent behaviour, the processes underpinning the use of single separation were not adequate”.

“Tusla regrets this and is currently taking steps to strengthen its decision making procedures and facilities,” Chief Operating Officer Fred McBride said in a statement.

“All young people in single separation have access to toilet and washing facilities. However, the reports references instances where this was not possible.

“Access was restricted when a risk assessment determined they were unsafe due to indications of self-harm.  On another occasion a viewing panel had to remain closed due to an unacceptable health and safety risk to staff and other young people.”

He said Tusla was developing a specially-designed “single occupancy facility” at Ballydowd which would be better equipped to deal with “extreme challenging behaviour”.

The Children’s Rights Alliance said that depriving a child of social contact “for prolonged periods of time and in inappropriate conditions can be very harmful”.

“It is our view that single separation facilities without basic sanitation should not be used,” CEO Tanya Ward said.

“Children should not be subjected to inhuman or degrading circumstances at any time.”

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